Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Riverside, IA | $69.94 | $54.59 – $75.13 | 8,829 | 4 |
| Lindenhurst, IL | $48.01 | $29.58 – $53.14 | 8,829 | 4 |
| Pamorama City, CA | $57.44 | $57.44 – $57.44 | 8,819 | 1 |
| Davidsonville, MD | $87.87 | $54.93 – $101.51 | 8,818 | 8 |
| Monticello, GA | $63.04 | $56.27 – $66.57 | 8,816 | 3 |
| Shoals, IN | $46.22 | $46.22 – $46.22 | 8,813 | 1 |
| Wading River, NY | $103.05 | $25.27 – $167.07 | 8,810 | 8 |
| Eureka, KS | $112.06 | $8.90 – $196.27 | 8,810 | 6 |
| Fort Gordon, GA | $53.49 | $29.30 – $121.09 | 8,808 | 13 |
| Marion, MI | $65.03 | $64.95 – $77.91 | 8,807 | 2 |
| Loogootee, IN | $50.93 | $29.70 – $85.77 | 8,807 | 8 |
| Manning, IA | $29.70 | $15.03 – $35.36 | 8,797 | 7 |
| Wormleysburg, PA | $65.11 | $14.43 – $110.54 | 8,791 | 17 |
| Sunbury, OH | $45.48 | $10.55 – $276.00 | 8,788 | 16 |
| Apple Creek, OH | $23.85 | $3.28 – $67.43 | 8,787 | 4 |
| Wanblee, SD | $450.49 | $360.43 – $457.87 | 8,786 | 2 |
| Clarkson, KY | $37.14 | $29.20 – $73.55 | 8,784 | 4 |
| Macclenny, FL | $58.16 | $0.00 – $105.40 | 8,783 | 20 |
| Curwensville, PA | $41.22 | $36.43 – $42.74 | 8,781 | 3 |
| Greenwich, NY | $61.55 | $48.29 – $81.00 | 8,776 | 8 |
| Bristol, PA | $45.51 | $1.87 – $84.12 | 8,774 | 19 |
| Ash Flat, AR | $30.94 | $0.00 – $81.01 | 8,774 | 5 |
| Calumet Park, IL | $60.50 | $59.50 – $91.59 | 8,771 | 4 |
| Mount Olivet, KY | $29.12 | $29.12 – $29.12 | 8,767 | 1 |
| Putney, VT | $48.32 | $15.47 – $128.69 | 8,763 | 7 |
| La Grange Highlands, IL | $55.70 | $1.53 – $102.94 | 8,760 | 15 |
| Wamego, KS | $92.63 | $20.09 – $251.59 | 8,743 | 20 |
| Tarentum, PA | $55.64 | $8.47 – $87.15 | 8,743 | 10 |
| Syracuse, UT | $59.18 | $37.18 – $77.15 | 8,733 | 12 |
| Dover Plains, NY | $82.19 | $66.68 – $95.43 | 8,731 | 5 |
| O'Fallon, IL | $60.43 | $4.94 – $66.90 | 8,726 | 7 |
| Big Clifty, KY | $31.66 | $28.96 – $35.52 | 8,723 | 3 |
| East Aurora, NY | $54.14 | $0.00 – $92.00 | 8,720 | 15 |
| Wewahitchka, FL | $42.44 | $0.00 – $131.42 | 8,720 | 5 |
| Buena Vista, GA | $81.19 | $39.82 – $115.08 | 8,710 | 4 |
| Santa Claus, IN | $62.09 | $59.55 – $64.78 | 8,710 | 2 |
| Mccall, ID | $33.87 | $0.00 – $82.77 | 8,710 | 15 |
| Onarga, IL | $1.93 | $0.00 – $38.22 | 8,710 | 2 |
| Paulding, OH | $38.10 | $14.04 – $49.63 | 8,709 | 8 |
| Vidor, TX | $33.03 | $0.86 – $38.03 | 8,709 | 5 |
| South Deerfield, MA | $47.39 | $32.18 – $58.04 | 8,706 | 3 |
| Scammon Bay, AK | $253.81 | $42.71 – $440.35 | 8,705 | 7 |
| Pounding Mill, VA | $51.05 | $29.83 – $62.98 | 8,704 | 6 |
| Westcliffe, CO | $86.73 | $69.95 – $127.51 | 8,702 | 4 |
| Grantsville, MD | $120.47 | $49.11 – $303.28 | 8,698 | 8 |
| Kathleen, GA | $124.61 | $123.91 – $630.00 | 8,696 | 2 |
| East Machias, ME | $9.22 | $6.34 – $44.40 | 8,694 | 2 |
| Mccook, NE | $35.44 | $12.00 – $89.63 | 8,690 | 5 |
| Helper, UT | $57.22 | $5.40 – $66.21 | 8,689 | 3 |
| Swainsboro, GA | $38.14 | $22.03 – $115.71 | 8,686 | 7 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.